Guideline-Concordant Antibiotic Use in Children With Community-Acquired Pneumonia

Area of Science:

• Pediatric Emergency Medicine
• Infectious Diseases
• Antibiotic Stewardship

Background:

• National guidelines exist for appropriate antibiotic therapy in pediatric community-acquired pneumonia.
• Significant variation in antibiotic decision-making is observed in clinical practice.
• This study addresses the need to understand guideline adherence in pediatric pneumonia treatment.

Purpose of the Study:

• To determine the prevalence of guideline-concordant antibiotic use in children with pneumonia.
• To identify factors associated with appropriate antibiotic prescribing in the emergency department (ED).

Main Methods:

• Children under 18 with clinical and radiographic pneumonia were enrolled in 2 US children's hospitals.
• Guideline-concordant antibiotic use was defined by the 2011 Infectious Diseases Society of America pediatric pneumonia guideline.
• Multivariable logistic regression analyzed associations between patient characteristics and antibiotic use.

Main Results:

• 74.2% of 772 children received antibiotics; 57.1% received guideline-concordant treatment.
• Antibiotic use was less likely with interstitial radiographic findings and negative viral testing.
• Guideline-concordant treatment was more likely with chest indrawing and less likely with effusion.

Conclusions:

• A substantial proportion of children with pneumonia receive antibiotic treatment inconsistent with established guidelines.
• There are clear opportunities to enhance appropriate antibiotic use in pediatric pneumonia management.
• Improving adherence to guidelines can optimize patient outcomes and combat antibiotic resistance.